This unannounced comprehensive inspection took place on 9 October 2018. This meant neither the provider nor the staff knew we would be arriving.

Princes Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Princes Court also had a rehabilitation unit which is ran in partnership with the NHS.

At the time of our inspection 50 people with physical and mental health related conditions permanently lived at the service. Additionally, ten people were using the rehabilitation service on a temporary basis.

At our last three inspections, we rated this service as requires improvement. At the last inspection in October 2017, the service had undergone significant changes within the provider organisation and management. We saw improvements had been made but we wanted to be certain that the good practice they had started to implement would be sustained. At this inspection, we found that good practice had been sustained and there were many more improvements to the service.

The manager who was newly appointed at our last inspection was now registered with CQC. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The clear management structure remained in place and this had been strengthened with the appointment of permanent staff in key roles such as a deputy manager/clinical lead and nursing staff. The service was not using any agency workers.

People told us they felt safe living at Princes Court. The family members we spoke with confirmed this. Policies and procedures were in place to support staff with the safe and effective delivery of the service. Staff were trained to safeguard vulnerable adults and they told us that they were aware of their responsibilities with regards to protecting people from harm.

The registered manager ensured all accidents and incidents were reported where appropriate to the necessary authorities. Records showed an investigation had taken place and there was an outcome documented. The registered manager analysed accidents and incidents to look for themes or trends and put measures in place to reduce the likelihood of a repeat occurrence.

There were comprehensive risk assessments in place. Risk assessments accurately described people’s current needs and the specific risks they faced. Staff were aware of how their positive actions could minimise risk.

The management of medicines was safe. We found no issues with the receipt, storage, administration, disposal or recording of people’s medicine.

The home was clean and tidy. All staff prevented and controlled the spread of infection by following best practice guidance. We observed ample domestic staff were on duty. The home was nicely decorated and areas of the home had been fully refurbished or refreshed. The premises were well maintained and regular checks were completed by internal and external personnel on the safety of the utilities and equipment.

Staff recruitment was safe and there were enough staff on duty to meet people’s needs.

Staff were fully supported in their role by the registered manager and senior staff. New staff had been enrolled onto a robust induction programme. Staff training was up to date. All staff attended regular one to one supervisions sessions and an annual appraisal. The provider had assured themselves that staff were competent to provide safe care.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made

We carried out an unannounced comprehensive inspection of this service on 13 and 14 December 2016 and rated it as ‘Requires Improvement’. We found the provider to be in breach of four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices in respect of these. Subsequently, the provider sent us an action plan setting out the immediate and on-going improvements they intended to make. We also requested that the provider updated us on a weekly basis of the progress against the action plan.

After that inspection we received further concerns in relation to the safety and governance of the service. As a result of this, a multi-disciplinary team decision was made to place the service into North Tyneside Council’s ‘Organisational Safeguarding Process’. This meant that outside agencies such as North Tyneside’s safeguarding and contracts monitoring teams, the Clinical Commissioning Group (CCG) and the Care Quality Commission (CQC) met regularly with the provider’s representatives to implement and monitor a comprehensive action plan in order to ensure people who used the service were safe.

In August 2017, after eight months of closely monitoring the service, a decision was made to remove the service from the organisational safeguarding process following the provider’s completion of an action plan and positive feedback from all agencies about the improvements to the service.

We undertook this focused inspection on 6 September 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Princes Court on our website at www.cqc.org.uk.

Princes Court is a residential care home situated in North Shields. It provides accommodation, nursing and personal care for up to 75 people with a wide range of health related conditions. The service also has a newly established NHS led rehabilitation unit for patients who require intensive support after a hospital admission before they can return home. At the time of our inspection 38 people used the residential service at Princes Court and 14 used the rehabilitation service.

There was a new manager in post who had been employed by the provider at another care home and had recently transferred to Princes Court. They had applied to the CQC to become the registered manager at the service. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found the provider had made significant improvements throughout the service and were now complying with all of the regulations. There was a clear management structure in place and the governance of the service was robust. Additional audits and checks of the service had been implemented and policies and procedures had been updated or completely re-written. The most recent documentation demonstrated that the senior management team had thorough oversight of the service and that any issues identified were being addressed in a timely manner.

People’s care records contained up to date information including care plans. Risk assessments identified the specific risks people faced in their lives and information for staff on how to mitigate risks. Everyone we spoke with told us they felt safe living at Princes Court and their relatives echoed this.

Complaints records were up to date and formally recorded on the provider’s complaints monitoring documentation. The manager was in the process of responding to two families who had recently raised issues. Written acknowledgements of complaints and full explanations with corrective action and

This unannounced comprehensive inspection took place on 13 December 2016 and we returned on 14 December 2016 to complete the inspection. We visited the service again on 19 December to provide in-depth feedback to the home's care manager and a representative from the provider organisation. We previously inspected the service in February 2016 where we identified on-going breaches of the regulations which related to medicine management and governance. We also made recommendations around staffing levels and care plan reviews. There is a history of non-compliance with health and social care regulations at this service.

Princes Court is a residential care home situated in the Royal Quays area of North Shields. It provides accommodation, personal and nursing care for up to 75 adults with physical and mental health related conditions. At the time of our inspection 51 people lived at the home or were staying on a short term respite basis.

The person in charge of the day to day running of the service was known as the 'care manager'. They had been employed by the provider for several months. They were awaiting the outcome of their application and assessment by the Care Quality Commission (CQC) to become the registered manager of the service. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The governance of the service had not been thorough and effective. Internal audits and monitoring of the service had taken place however this had still not been robust enough to identify the issues we highlighted during our inspection. A new operations director had drafted a service improvement plan and reviewed it weekly. Following our inspection, the management team sent us an immediate action plan to address the shortfalls throughout the service.

We examined eight individual care records thoroughly and found that all of them contained inaccuracies or incomplete forms and some documentation held within the records were not always signed and dated. Improvements had been made with updating support plans to make them more detailed and person-centred. We saw ‘service user profiles’ were completed with personal information about life history, interests, hobbies and preferences.

Record keeping was poor in aspects of the service such as food and fluid monitoring, weight charts and positional change records which caused us concern and we asked the care manager to address this immediately. Individual risks which people faced in their daily lives were identified and control measures were in place to reduce the possibility of people coming to harm although these had not always been completed accurately or in a timely manner.

People who required nutrition and hydration support or were unable to swallow food and/or medicine due to the risk of choking where not always supported in the most effective way. Inadequate record keeping meant we were unable to ascertain if people’s needs in this area were met in the safest possible way.

During the inspection some relatives brought concerns to our attention which we immediately raised with the care manager. There had been three previous incidents of a safeguarding nature which had been investigated by the local authority safeguarding team since our last inspection. Two of which were upheld and one was still on-going. The provider was working with other external agencies such as the Clinical Commissioning Group (CCG) to improve the service it provided.

The complaints policy and procedure in place was dated 2012 and the care manager told us this was the most up to date version they had. We reviewed the information kept in the complaints file and found that the care manager had not used the provider’s complaints form and complaints register in line with

The unannounced inspection took place on 2, 4 and 10 February 2016. A previous inspection undertaken in April and May of 2015 found there were breaches of legal requirements in two areas relating to safe care and treatment and good governance.

Princes Court is divided into three units and provides nursing and residential care for up to 75 people, some of whom are living with dementia. At the time of our inspection there were 68 people living at the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found on-going issues with the management of medicines. Concerns that we found at our last inspection were still occurring. We also found additional issues that needed to be addressed.

We found further issues with the recording of information within people’s care records. People’s care records were reviewed regularly. However, we found some documentation relating to food and fluid recordings were not fully documented to show the levels of intake. We checked that people's food and fluid needs were being met and observed this to be the case throughout our visit.

Accidents and incidents were recorded and monitored for any trends forming. Risks to people were mitigated by staff completing risk assessments and monitoring these for any changes. Emergency procedures were in place, including suitable fire safety procedures.

People told us they felt safe and their relatives confirmed their feelings. Safeguarding procedures were understood by staff and they were able to tell us what they would do if they suspected or had any concerns. The provider displayed procedures throughout the service to support staff with any actions they may need to take of a safeguarding nature.

We found the service to be clean, tidy and appropriate standards of maintenance appeared to be in place.

The Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. We found the provider was complying with their legal requirements.

There was generally enough staff at the service although we have made a recommendation to the provider to ensure that this remains the case. Safe recruitment procedures had been followed to ensure staff were suitable to work with vulnerable people. Staff were given opportunities to develop their skills and understanding. There were some areas for improvement, but a staff training programme was in place and the registered manager was working to ensure that all staff received suitable training to match their role. An induction process was in place to ensure new staff were competent to deliver care to people safely.

A selection of food and refreshments were available and people told us they generally enjoyed the food. One person told us, “The food is canny [good], better than when I cooked for myself!” People who were in need of additional support because of their special diet were well supported.

People told us they had access to health care professionals if they needed additional support. For example, from GP’s or chiropodists.

Adaptions to the building had been made, including clear signage and the registered manager planned to have the sensory garden for the dementia unit ready for the summer.

Staff were kind and treated people with respect and dignity. We observed people who were anxious or upset being comforted. One relative told us, “The staff are really kind. I cannot fault them.”

People told us they had choice. People told us they could ge

At the time of the inspection there were 50 people living at the home. Due to their health conditions and needs not all people we spoke with were able to share their views about the service they received. During our visit we spoke with eight people who used the service and observed their experiences. We spoke with the registered manager, eight members of staff and two visiting relatives.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found;

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to previous noncompliance against the regulations and we did not look specifically at this area.

Is the service safe?

We found that improvements had been made to the premises since our last visit. People were protected from the risk of infection. The home was clean and had systems in place to monitor and manage the risk of infection to people who used the service and visitors.

The home had undergone a large renovation and the environment was safe and suitable for people to use. The premises were well maintained and secure.

Is the service effective?

This was a responsive inspection to previous noncompliance against the regulations and we did not look specifically at this area.

Is the service well led?

We saw the manager at the service was registered with the Commission in line with the requirements of the registration of this service and location.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. At the time of our inspection the provider did not have a registered manager in post. A temporary manager had commenced employment at the home on the day of our inspection.

We saw that people's needs were assessed and their care and treatment was planned and delivered in line with their individual care plans. People told us they were well looked after and they were provided with a good service that met their needs. Comments included, "The girls are very good" and "I am very happy here and I love being with everybody."

The provider did not have adequate systems in place to reduce the risks of infection to protect people's health and safety.

We found that the management of medicines was appropriate and people were protected against the risks associated with medicines.

Appropriate measures were not in place to ensure the premises were well maintained throughout to provide people with a safe and suitable place to live.

Staff were well supported and received regular supervision to help them carry out their roles. The staff told us they received good training and the management were very supportive and approachable.

We were unable to speak to some people who used the service because of the nature of their condition. We spoke with five people who used the service and three visitors. Positive comments were received about the quality of care. People said the staff were very caring and the manager very approachable. They said they would be confident to make a complaint if necessary and said they felt this would be taken seriously and thoroughly investigated. Comments included, "The staff are very helpful and kind", "They all seem to care and are always available". One visitor said, "I feel content that he is well looked after here".

We found that people's privacy and dignity were respected and they received appropriate care which met their needs. One person said, "The staff always knock on my door before coming in and let me help myself as much as I can".

Although some parts of the premises were showing signs of wear and tear a plan was in place to address this in the near future.

There were systems in place to help ensure appropriate and competent staff were recruited to care for the people who lived in the home.

The provider had effective systems in place to assess and monitor the quality of service that people received.

We observed the care provided to people living in the home and spent time looking around the home. We did not speak to people about the outcome areas we assessed. We spoke to the staff on duty who confirmed they were receiving up to date training to help them carry out their roles effectively.

The unannounced inspection took place on 22 and 24 April and 5 May 2015. We last inspected Princes Court on 30 September 2014. At that inspection we found the service was meeting all the regulations that we inspected.

Princes Court is divided into three units and provides nursing and residential care for up to 75 people, some of whom are living with dementia. At the time of our inspection there were 60 people living at the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The management of medicines required improvement. For example, there were no written protocols for ‘as required’ medicines and we saw some people had duplicate medicine administration records in place, one typed and one hand written.

Risk assessments related to people’s care were completed accurately, which meant people were kept safe. Accidents and incidents were acted upon, recorded and monitored appropriately.

People told us they felt safe. One person said, “I have no worries here, I feel safe as houses.”

Staff understood safeguarding procedures and were able to describe what they would do if they thought a safeguarding incident had occurred. Staff assured us they would have no hesitation in reporting any concerns they had to the registered manager or other appropriate staff, either internally or externally to the service.

Emergency evacuation plans and procedures were in place and up to date, and the service had security systems in place to stop unauthorised entry into the property.

We found the service to be clean, tidy and odour free and standards of maintenance appeared to be good.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and DoLS. MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decisions. Applications to the local authority were in the process of being made where a DoLS was required.

People confirmed staff asked for their consent before embarking on any personal care and we heard examples of this during the inspection.

We felt there were not enough staff in some parts of the service and the registered manager agreed and confirmed after the inspection that this had been rectified. The registered manager had procedures in place to ensure any staff recruited were suitable to work within the service. There was a training programme in place and staff development was monitored by the registered manager to ensure they had up to date knowledge and any training needs were met. The registered manager had procedures in place to ensure staff felt supported.

A good selection of food choices were available and people told us they enjoyed the food. One person told us, “The food is very good, there is lots of choice.”

People told us they had access to health care professionals if they needed additional support. For example, from opticians or GP’s.

The building had been adapted to suit the needs of people living there, including wider access for wheelchair users. The registered manager told us they planned to secure the garden outside with a fence and convert some of the car parking areas to the front of the building to make an enclosed garden area for the people living in the dementia unit in particular.

People were treated with warmth, respect and dignity and cared for individually. We heard positive interactions taking place between staff and people living at the service and their relatives. One person told us, “Staff are fantastic, they are always smiling, never grumble and they are really, really wonderful.”

Care records were reviewed regularly although we found care plans had not been completed with the details required to ensure people’s needs were all met.

People told us they had choice. We saw people choosing what meals and drinks they would like. One person said, “I like to get up late, I should be able to at my age.”

People were able to participate in a range of suitable activities. We spoke with the activities coordinator who was passionate about ensuring people enjoyed themselves and had “things” to do. There was a St George’s day celebration that took place during the inspection period.

People and their relatives knew how to complain. They told us they were able to meet with the registered manager and staff at any time and were able to give feedback about the service.

From observations, staff appeared motivated, enthusiastic and told us they felt supported. One member of care staff told us she was has worked at the service for seven years and “loves it.”

The registered manager held meetings for people and their relatives and surveys were in the process of being sent out to gain the views of anyone involved with the service, including people, relatives, staff and other visitors or professionals.

The provider had systems in place to monitor the quality of the service provided. When issues or shortfalls were identified, we saw actions had been taken.

We found two breaches in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.